title: Feasibility of endoscopic resection in superficial esophageal squamous carcinoma.
abstract: BACKGROUND
  Endoscopic resection in patients with superficial esophageal squamous carcinoma (SESC) is limited by the presence of lymph node metastasis (LNM), highlighting the importance of determining which patients have virtually no risk of LNM.
  
  
  OBJECTIVE
  To investigate the clinicopathological parameters predicting LNM in patients who underwent esophagectomy for SESCs and to identify the best candidate patients for endoscopic resection.
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  Tertiary-care center.
  
  
  METHODS
  A total of 190 patients who underwent esophagectomy for SESCs between 1991 and 2009.
  
  
  METHODS
  Esophagectomy with lymph node dissection.
  
  
  METHODS
  LNM.
  
  
  RESULTS
  Of 190 patients, 39 (20.5%) had LNM. The rates of LNM in patients with m1, m2, m3, sm1, sm2, and sm3 lesions were 0.0% (0/18), 8.7% (4/46), 25.0% (6/24), 15.0% (3/20), 26.0% (7/27), and 37.3% (19/51), respectively. On multivariate analysis, lymphovascular invasion (LVI) (P<.001), superficial tumor size (P=.004), and lower LMM (lamina muscularis mucosae) invasion width (P<.001) were independent predictors of LNM in patients with SESC invading the LMM. Among 63 patients with mucosal or sm1 cancer 3 cm or smaller, only 1 had LNM without LVI showing a lower LMM invasion width greater than 3.0 mm.
  
  
  CONCLUSIONS
  Retrospective analysis.
  
  
  CONCLUSIONS
  Endoscopic resection should be performed for mucosal cancer of 3 cm or less without positive lymph nodes. Moreover, if pathological examination of the endoscopically resected specimens shows invasion of the sm1 layer and a lower LMM invasion width of 3.0 mm or less, indicating an absence of LVI, the patient can be carefully observed without additional treatment.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Kwi-Sook
authors.initials: KS
authors.lastname: Choi
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome